Author: John Lundin

In order for a marriage to have a fighting chance when one member is suffering from depression, it is crucial that their spouse understand what to say and what not to say in order to support their partner through a very painful time in their life. It is often difficult to know what to say to a depressed partner. As crucial as what we do say is what we don’t say to someone who is depressed. While the following list can apply to either gender, I have decided to create this article with men in particular in mind, since there are often differences in how depression manifests in men and women.

Additionally, men can be particularly sensitive to certain reactions and labels, due to messages they are sent by our culture from a young age. They are told that it is okay to feel angry, but not sad or afraid, for example, so it is often more difficult for men to recognize and discuss these feelings. Due to these differences and others, I have created the following for those whose partners are men suffering from depression.

1. Get over it. If you’ve been reading about depression you’ve probably heard this one before, and it’s a bad thing to say to anyone who is feeling badly, since it just encourages them to bury their feelings, making the problem much worse. Men may be especially sensitive to this one in certain ways since society sends them messages from an early age that certain feelings make them less of a man.

Men often feel ashamed of their depressive feelings, worrying that it means they are weak or somehow deficient, and telling them to get over it simply makes the depression worse. If they are made to feel more ashamed, they may start to pretend that they don’t feel depressed.. This can actually leave them feeling even more alone since they no longer safe to share how they feel. There is a whole myriad of ways to tell them to “get over it” including “look on the bright side,” “don’t dwell on it,” and or anything else that implies that they should feel differently than they do.

It is normal to want your partner not to be depressed since it makes life harder for both of you. However, the way to help them is NOT telling them how they should feel but being their teammate in their battle with depression. It is hard for many partners to believe that it is often helpful to sit, listen, perhaps even silently. They might feel they are doing nothing because they are saying nothing. However, in a culture that emphasizes doing over being, silent listening can be an incredibly valuable gift.

2. “I know exactly how you feel.” This sounds like it might be helpful, but in reality, we never know exactly how someone else feels, so this statement can, in fact, make the listener feel even less understood. Assuming you know exactly how another person feels doesn’t leave room for them to talk about their experience. It is a conversation stopper that can make the depressed person feel more alone rather than less. It is a common misconception that people who are suffering need you to feel exactly how they feel. Although they may express a desire for this, it is not necessary in order to be helpful. You only have to demonstrate that you are interested and willing to listen. In that process, you might LEARN how they feel, thereby growing more connected with each other, which is about the best thing in the world for your depressed partner.

3. “Don’t be so angry.” A very common if not a universal symptom of depression is irritability or anger. The roots of depression lie in the misplacement of anger on oneself, so it is very important that a person who is depressed be given the space to feel angry. Ironically, the safer they are to feel angry, the less depressed they will be. This is a complex concept that can easily be misunderstood, but the main point for spouses is to make sure not to send messages that they are wrong for feeling anything, especially anger. This DOES NOT mean that it is okay to EXPRESS this anger in any way they like. There are constructive and destructive ways of expressing it. Attacking or berating, or expressing anger that is in any way physically intimidating is NOT okay and it is important to set limits around any such behavior. You are not obligated to tolerate any of this behavior, and it is VERY important to separate FEELINGS from BEHAVIORS.

A constructive way of expressing it would be to talk about how they feel or channel into a productive activity. Saying, “I’m feeling very angry right now,” can be very constructive. Making space for anger can then lead to deeper discussions where you can uncover feelings buried beneath the anger. By the way, this item applies even more to women, as women in our society are often taught that it is not okay to feel angry, so men, you need to be an advocate for the women in your life to be allowed to feel angry as well. My next article will on what men shouldn’t say to their wives who are suffering from depression.

4. “Just leave it to me.” It is very important to remember that it is not your responsibility to cure your partners depression. This can lead to many unhealthy, sometimes called codependent, dynamics. Not only is taking responsibility for your partner’s depression a set up for failure, but it is also a set up for you to feel resentful of them when it ultimately doesn’t work. Additionally, your partner will then begin to feel more like a failure because they aren’t getting better, and feel like they are letting you down. If you find yourself feeling responsible for your partner’s depression, it is a red flag that you probably need to seek treatment yourself.

Understanding their depression and its relationship to anger is HIS job to work out with a therapist. Your job is just to try to know what you can and can’t do AS HIS PARTNER to support him. EVERYONE is responsible for their own feelings and behavior, even as they may struggle to understand and control them.

To summarize:

Partners should: Encourage their partner to get into treatment. Listen without judgment. Offer affection and support. Remind your partner that they are lovable.

Partners shouldn’t: Feel responsible for their partner’s depression. Feel frustrated with themselves if the depression doesn’t go away. Blame their partner for their depression. Discourage anything that they are feeling, as long as it is done safely. Convey the message that they should simply be able to get over it in any way.

Depression can sometimes take a long time to treat, so it is important to be patient. However, with good quality therapy and support from those they love, most depression is very treatable. Treatment can bring rewards that one never thought possible. Beneath depression often lies hidden energy, talents, and passions that the sufferer hadn’t felt in years, or didn’t even know they had, so there are plenty of reasons for hope if you are patient with yourself and your partner.

1. What’s surprised you the most about being a therapist? I was surprised by how complex, difficult, and life changing the process of becoming a therapist was for me. Like most therapists, when I first started out I thought psychology was fascinating, and I just wanted to help people. In my first clinical placement, at The Salvation Army, I learned how difficult the work was, not just from an intellectual perspective, but from an emotional one. Many people assume the hardest part about being a therapist is hearing sad stories all day. While patients’ stories were often quite sad, what surprised me was the personal emotional investment the work required and the way the work gets inside you. It surprised me how both powerful and disrupting it can be to fully absorb another person’s emotional experience, especially the most disturbed parts of them. I quickly learned that in order to help my patients most effectively, I had to allow myself to be truly open not just to the content of what they are saying, but the emotions and experiences that come up in the room while I am with them. I have learned that it is only when we have allowed ourselves to experience as much as possible of our patients’ emotional lives that we can find the words and expressions that can finally help them to heal. You can’t really get away with merely being a bystander if you want to really help your patients. The field as a whole is finding out that the process of healing in therapy more and more requires a process that is similar to how a parent attunes to their young child’s emotional life. The process of having one’s emotional life recognized, respected, and understood is the basis for how we learn that we are lovable, and also learn to love.

Like many therapists, I came from a family where I was often in the caretaker role. This can be a problem when a therapist feels they need to “fix” a client by helping them to feel better, rather than “being” with them first, and figuring out how to help from there. I would say I was still helpful to the people I saw in my first year, partly because I had already had a good deal of therapy myself beforehand, but doing the work required a whole new level of self-exploration. We have to be with them, and take responsibility for their therapy, while at the same time letting go of responsibility for “fixing” them. If a patient senses that WE need them to get better, that’s not good. Holding and negotiating these tensions in the treatment is highly important, but very difficult for a would-be therapist to imagine before they get into the work.

2. What’s the latest and greatest book you’ve read related to mental health, psychology or psychotherapy? The Body Keeps the Score by Bessel van der Kolk is a wonderful book about trauma that combines a neuroscientific and psychological perspective. It is a fascinating account of how the brain and body hold, express, and release trauma. I think it’s a must-read for therapists, and there are some exciting new therapies that I’m sure will come out of the work he is describing.

3. What’s the biggest myth about therapy? I would say that the biggest myth is that a therapist is just someone who listens, or just reflects back what a patient is saying. The depiction of therapists in Hollywood is often that of these pushovers who overanalyze and don’t really do much to help, when the best therapists have clear boundaries, are deeply engaged with their patients, and are often both literally and figuratively saving lives. To go a little deeper, I think this depiction is a reflection of the fears people have about therapy who either haven’t tried it, or have had negative experiences. The idea that a therapist can see things in your emotional life of which you aren’t aware about can be very threatening to the image we have of ourselves as the captain of our ship.

4. What seems to be the biggest obstacle for clients in therapy? Lucille Ball once said, “Love yourself, and everything else will fall into place.” I really agree with this statement. Difficulty loving oneself is also the thing, at base, that brings most people into therapy. It sounds simple, but it is anything but. Self-love is often misunderstood, and gets confused for its opposite, self-obsession. People that talk about themselves all of the time and have no room for others are doing the opposite of self-love: They are self-obsessed because they don’t love themselves enough to be able to relax and enjoy others. I believe that figuring out the obstacles to feeling safe to be truly yourself is the ultimate aim of therapy.

5. What’s the most challenging part about being a therapist? To figure out how to digest all the emotional material that comes up in a treatment, feed it back to the patient in a way they can digest, and do this in a way that feels like it’s coming from you instead of hiding behind theory or technique, is quite a challenge. Another way of putting this is that the ultimate challenge and goal as a therapist is to learn to love yourself, because if you can do this, it will be much easier to help others do the same. Here is the real taboo that isn’t often talked about in these terms by therapists because there is a danger of it sounding trite: We heal our patients by acting lovingly toward them in a particular way, and we cannot show someone love and acceptance if we don’t know how to love ourselves. To give you an example, much of therapy involves helping people to digest their anger in a way that’s more productive. It is common for a patient to get angry with a therapist in this process, even say attacking things towards them. If the therapist is overly insecure, they will be much more likely to attack back, which obviously can cause problems. Just like in a relationship with a spouse or one’s child, love often takes the form of not retaliating, but digesting the anger and trying to do something useful with it, rather than collapsing or retaliating. I would call that a form of love, albeit one that isn’t often thought about as love. Being verbally attacked is surely not what people picture when they imagine becoming a therapist, but if the therapist can find a way to digest what it means that the patient is angry, and feed that back to them in a way they can hear, such moments can be transformative.

6. What do you love about being a therapist? What I love most about being a therapist is hard to put into words, because I think it involves some of the most profound aspects of being human, and we don’t have words for all of that. But I will say that it has something to do with the deep sense of connection I feel to my patients, and the joy that I feel when I see a patient begin to connect with their true selves in ways they have never done before. You can feel them come alive, and it is truly breathtaking. These moments make all the difficult stuff very worth it, and make me feel truly lucky to be doing the work that I do.

7. What’s the best advice you can offer to readers on leading a meaningful life? M. Scott Peck said, “If you pursue happiness, you might be disappointed. If you pursue love, happiness will follow.” As I have already said, learning how to love others starts with learning how to love yourself, and that is an ability that’s really hard to learn through books or by yourself. In other words, it often requires therapy. Also, learning how to appreciate the small things in life and be grateful for what you have is vital to feeling satisfied. This has been described in many ways by many authors, but is connected to the idea of being present to your immediate experience of the world, for inside you and outside of you. In sum: Try to be present, concentrate on being able to be fully yourself, and on having satisfying relationships in your life. If you find any of these too difficult to do on your own, which most people do at some point, find a good therapist!

8. If you had your schooling and career choice to do all over again, would you choose the same professional path? If not, what would you do differently and why? I would probably choose the same path. I think that I underestimated how much meaning I could get from other careers when I first started out. But it’s hard to imagine myself doing anything else, especially since being in the field has changed who I am for the better. I think it would have been impossible to know the changes that would come about in the field as a whole, such as the need to market on the internet, etc., but which have changed the field a great deal. I still would have done the same thing, I believe, but I would have taken a business class or marketing much earlier. Many therapists are good at helping people, but have trouble earning a living for themselves. I was one of them, but I’ve learned that we can’t help our patients if we don’t take care of ourselves.

9. If there’s one thing you wished your clients knew about treatment or mental illness, what would it be? I try to tell them the things that I wish they knew if I feel it is helpful, but what I try to help them really absorb is that it is their illness or neurosis that causes them to feel that they aren’t enough. It’s not reality. Many people also believe that they shouldn’t have mental illness because it is “just in their head” as if that means they should have control over it, when in fact we are in control of only a small portion, albeit an important portion, of what goes on in our heads. To accept that their suffering is not their fault is a huge relief for patients. It’s hard enough to suffer from mental illness without beating yourself up or feeling shame for suffering. However, beating yourself up is also often part of the mental illness, which some patients have a hard time letting go of, for various reasons.

10. What personally do you do to cope with stress in your life? I like to laugh, so comedy in all forms is really important in my life. I even use it in my work, when appropriate. I am on a soccer team with friends, which is really helpful to me, because it gets my body moving and inspires me to keep in shape so I don’t collapse on the field! It’s also a social outlet and kind of a meditative exercise for me. I play goalkeeper, and when I’m in goal, I can’t think about anything else besides what’s in front of me: the ball, the players, and the field. Even the wind is important to take into account at times, so it really puts me in touch with my surroundings and gets me out of my head, which is important after a week of sitting and listening. I think anything that can take us out of our heads for a little while can be very valuable. Last but not least, I try to minimize distractions when I’m with my friends and family so that I can enjoy the heck out of them. Over the years, I have learned to be more fully myself in all contexts, which is related to being able to be present. Life is not as stressful if you’re not trying to be someone more than you are. That doesn’t mean you don’t make mistakes and learn from them; it just means that it’s possible to take your flaws into account, and still feel important and lovable. Again, learning to really feel love for yourself is the work of therapy and I think the key to leading a life that is as happy and stress-free as possible.

I was interviewed for an article on Psych Central about where anxiety comes from and how to deal with it. The author interviewed me along with other anxiety experts in the field. A copy of the article is posted below. I hope you find this helpful. Comment on the page or call or email me with any questions!

When Anxious Thoughts Just Won’t Quit

“You can’t stop worrying about work. You’re convinced that you are an impostor, and everyone at the office knows it, too.

You’re bound to get fired. Maybe you fear that your partner will abandon you, because you know you’re not enough. Maybe you fear for your family’s safety after your neighbors were killed in a car crash. Maybe you’re worried about your own health after experiencing certain symptoms.

Maybe your thoughts involve a different anxiety. Either way, you carry them wherever you go. They are stubborn. They are persistent.

Maybe you’ve already tried – to no avail – to reduce or eliminate these thoughts? Maybe you’ve tried to distract yourself to cover up the anxiety?

Ryan Howes’s clients have tried moving all day long and then listening to music or watching TV to drown out their thoughts. “They exhaust themselves and collapse into sleep quickly so the thoughts don’t have time to plague them.” But because this doesn’t actually treat or reduce the thoughts, they continue to linger, he said.

Some of Howes’s clients try to combat the thoughts with logic, which sometimes works. But anxiety is adept at finding “loopholes and exceptions.”

Some people with generalized anxiety disorder (GAD) alternate between different persistent thoughts. “They might become fixated on the idea that they’re going to have a heart attack for a week or two,” said Howes, Ph.D, a psychologist and writer who specializes in anxiety. “Then that changes into a deep anxiety they’re going to lose their job, followed by a preoccupation that one of their children will get hurt, and on and on.” Their anxiety, he said, simply shape-shifts into other concerns.

Persistent anxious thoughts may be rooted in early experiences or deeply emotional experiences where we learned that we are inadequate, unlovable and unsafe, said John A. Lundin, Psy.D, a psychologist who specializes in treating anxiety in adults, teens and children. In fact, he said, most persistent thoughts stem from these questions: “Are people judging me?” “Will people reject me?” “Will I reveal myself to be fundamentally inadequate?” “Will I mess something up if I am myself?” or “Am I safe in the world?”

Overall, Howes believes that persistent thoughts point to a deeper issue, whether it’s an underlying disorder, unresolved trauma or a psychological wound. He gave this example: A person who was physically abused may have a fear of intrusion, conflict and unlocked doors.

If you’re struggling with stubborn anxious thoughts that just won’t quit, seeing a therapist can be tremendously helpful. Below, Howes and Lundin shared tips you can try.

Go to the source

According to Howes, our fears are primal. They stem from the older parts of our brain (the limbic system). We also have very active imaginations that create all kinds of terrifying what-ifs and stories. “[T]he images come from the most recently evolved part of the brain, the pre-frontal cortex.”

The key is to go to the source, he said, and calm our fear response in the limbic system. Because doing so, “sends an all-clear sign to the rest of the brain, and we don’t need to be in fight or flight.”

This is why Howes suggested practicing deep breathing, which is one way to send the all-clear. “Breathe in deeply and slowly until your belly pushes out, slowly exhale, and repeat several times.”

Another way is progressive muscle relaxation, which eases overall tension and stress. As Howes noted, “Releasing the stress and tension in this physical way can help reduce the fuel that feeds persistent anxious thoughts.” Simply start by flexing your feet for three seconds. Then relax them. Next flex your calves for three seconds, and relax them. Do the same with your thighs, moving up your body, all the way to your face.

Process trauma

If your anxious thoughts are tied to physical or sexual trauma, it might be helpful to read books such as The Body Keeps the Score or The Courage to Heal Workbook, Howes said.

He also mentioned these other options: joining an online or in-person support group for trauma survivors; taking a self-defense class; and expressing your thoughts and feelings through art, journaling or talking to friends you trust.

Surround yourself with supportive people

“Spend time with those you love, and who are good at making you feel good about yourself,” Lundin said. Most of our core anxieties, he said, are relational, which is why surrounding ourselves with people who genuinely care about us can help. It “reassures us that we are lovable, and reduces many of our core anxieties.”

Capitalize on your imagination

Take advantage of your active, rich imagination. Visualize a place that is peaceful and makes you happy, Lundin said. Imagine the details: what it looks, smells, sounds, and feels like. When your thoughts inevitably wander, he said, keep returning to this serene place.

For some people, this exercise may not be helpful (no matter how much you practice, your worries keep bombarding you). If it only spikes your anxiety, try something else. Experiment with these techniques, and use the ones that resonate with you.

You may, understandably, feel very frustrated when the same anxious thoughts send you spinning. You might be exhausted. You might want a break. So you start seeing your anxiety as the enemy, as something you must vanquish. And you start getting very angry with yourself. You start feeling ashamed that you’re anxious and can’t control your own thoughts, which are bumping around in your brain.

But berating ourselves only stresses us out even more, amplifying our anxiety. Plus, you don’t deserve it. Instead, Lundin underscored the importance of forgiving ourselves and our “over-taxed brain for still being anxious.” Accept your anxiety. Try to understand its roots. Try different calming techniques.

If you’re still struggling, that’s OK. Seek extra support from a therapist who specializes in anxiety. Because anxiety is highly treatable. You don’t have to suffer.”

I hope the beginning of September is finding you well. Just a quick note to announce that the full Psych Central article on depression has now been published, with myself and other experts chiming in with our thoughts on coping with depression.

Hopefully you will find it useful. A copy of the article is posted below. Please subscribe to our newsletter or share if you like.

Words of Hope for Anyone Struggling with Depression

One of the worst parts about depression — and there are certainly many — is that it robs you of hope. Hope that you’ll actually feel better. Hope that the darkness will lift. Hope that the emptiness will fill up and you’ll feel motivated and excited. Hope that it won’t be like this forever. Hope that you’ll get through it.

“I’ve been struggling with depression for almost 35 years,” said Douglas Cootey, who pens the award-winning blog A Splintered Mind. “In that time, I have often felt hopeless, usually during times of suicidal ideation…Depression has a way of warping our outlook so that we only notice the bleakest parts of the world.”

The darkness stops feeling like a lens that distorts your reality, and starts to become your reality, said John A. Lundin, Psy.D, a psychologist who specializes in treating depression and anxiety in adults, teens and children in San Francisco and Oakland, Calif.

“Depression often robs you of the memory of joy or happiness, so it becomes difficult to draw on happy memories to give one hope for the future,” Lundin said. Depression even makes hope seem foolish, like an illusion, he said.

Many people with depression aren’t able to articulate that they feel hopeless. Because doing so requires putting “words to an experience that just feels as real and encompassing as the air they breathe.” Saying you feel hopeless, Lundin said, can actually be a positive step. “[I]t holds the implication that hope is something that is possible.”

“Depression can be overwhelming,” said Cootey, also author of Saying No to Suicide: Coping Strategies for People Dealing with Suicidism and for the Loved Ones Who Support Them. “All those negative emotions are suffocating. This makes it difficult to believe that things will get better.”

Most of Rebecca Rabe’s clients say they’ve lost hope because they feel alone. They feel like no one understands what they’re going through. They feel like they can’t talk to anyone.

Loss of hope also might represent a loss of belief that you matter or that you can be loved, Lundin said. (This is something he works on with clients, helping them understand why they don’t feel adequate or lovable.)

What can you do when hope feels unfamiliar or impossible? What can you do when you’re in the middle of the storm?

Cootey stressed the importance of using a wide variety of coping strategies. “When I use my coping strategies to overcome depression, the next day isn’t a prison of more of the same. It’s a brand new day free of the sadness.”

Colleen King, LMFT, a psychotherapist who specializes in mood disorders and also has bipolar disorder, stressed the importance of having a treatment team and support system. This might include a therapist, doctor and several friends and family. Ask them to help you remember the times when you’ve felt better, she said. Ask them to “encourage you to be in the moment when you do experience temporary joy, even if it’s for a few minutes.”

Both King and Lundin suggested participating in activities that feel nourishing to your soul, activities that you love to do when you’re not depressed. Do them even if you don’t feel like it, King said. “You will most likely alter your mood at least a little bit, and [the activity] may be a welcome distraction from depression.” Plus, it helps to “arouse glimmers of hope that you can feel whole and healthy, again.”

It often feels like depression will last forever, King said. Which is why she also suggested placing prompts at home and work to remind yourself “that you are having a depressive episode and that it’s not a permanent state of being.”

Don’t underestimate the power of small steps. Rabe, LMFT, who specializes in treating children, teens and young adults with depression, anxiety and trauma, shared this example: She worked with a woman who was struggling with depression and complained about “not being able to do anything.”

They worked on tracking small but significant accomplishments and setting small goals. “For example, she would strive to check 10 things off her list. Sometimes just getting to therapy got her these 10 checks.” After all, getting to therapy is anything but trivial. It involves getting up, showering, getting dressed, driving to the office, making the appointment on time, talking in session and driving home, among other tasks. Her client also started reaching out to supportive loved ones (instead of isolating herself); taking walks; and writing in her journal—all of which has helped to diminish her depression and create a more positive outlook.

“I’ve been through the worst my mind can throw at me. I’ve felt the pain of suicidal depression,” Cootey said. “I’ve wished and even planned for my own death, yet I learned an important truth: Depression lies to us.” This is another reason it’s helpful to surround yourself with support: These individuals can help you see through the lies, he said.

“You do have worth. You will overcome this. You won’t be sad forever.”

There is always hope for someone struggling with depression, Rabe said. “People are resilient human beings, and they can do so much more than they think they’re capable of.”

Also, remember that “how hopeless you feel does not correlate to whether you can feel better,” Lundin said. Depression is an illness that extinguishes hope. It’s the nature of the disorder.

Thankfully, therapy and medication can help. So can participating in support groups. “Some depression requires a short treatment to work, and other takes a long time. But I have never met a patient who didn’t see significant progress if they stuck with it.”

If your therapist or doctor doesn’t seem to be helping, seek out new providers, King said. “Having a trusting and caring treatment team greatly assists with creating confidence and hope for the future.”

For people who don’t respond to therapy and medication, other treatments are available, such as transcranial magnetic stimulation (TMS) and electroconvulsive therapy (ECT), Lundin said.

With good treatment, effective and varied coping strategies and compassionate support, you can feel better. The heaviness gets lighter. The world becomes brighter.

So no matter how hopeless you feel right now, please don’t throw away your shot. Hope and relief are not some foolish illusion. They are real. They are possible.

Many people are living with a spouse who is depressed and are suffering because of it. Depression can be frustrating and difficult for a spouse to know what to do.

“I’ve tried everything I can think of. No matter what I do to cheer him or get him out of the house, it doesn’t help, and sometimes just leads to an argument. Then I feel so bad afterwards, because I know he’s suffering too. Then I wind up being dragged down with him.”

Depression can be subtle (called Dysthymia) or dramatic (called Major Depression). Depression is a term that’s used to describe many things, but generally refers to a set of symptoms that can range from the very subtle, like a general sense of the blahs, to very extreme symptoms like not being able to get out of bed or suicidal acts. It is important to be knowledgeable about what the warning signs are, so you can take action before they get worse. Any of the following symptoms are concerning in themselves, and can often be treated through therapy. Medical reasons for these symptoms should also be ruled out first. It is also important to bear in mind that everyone is different, and no one is just a set of symptoms.

Having said that, here are a few warning signs:

Loss of interest in activities

A depressed patient of mine found himself without any interest in sex, and felt very ashamed that he couldn’t “perform,” any longer. This made it very difficult for him to speak to his wife about his depression, afraid judgement, and hurting his wife’s feelings since she worried about her attractiveness. The shame and worry he was feeling made his depression worse. Loss of interest isn’t limited to sex, of course. A loss of interest in hobbies, sports, sex or work can be an indication that your partner has become depressed.

Irritability

“No matter what I say, he seems to take it personally.”People who are depressed can be sensitive and grouchy, and therefore difficult to be around. In addition to having a cloud over their head, depression can make him irritable, often snapping at others, or have a dark or cynical world view. Partners can struggle with feeling badly for their depressed loved one while at the same time feeling frustrated with them due to the toll that their depression takes their relationship. If you feel angry at your depressed spouse, bear in mind that a certain amount of this is normal and inevitable. In order for your relationship to survive, it is important to find ways to express these feelings as productively as possible, which I’ll discuss in “4 Things You Should Do If You’re Partner is Depressed.” (Coming soon).

Social isolation

People who are depressed often lose interest in socializing with friends and family, feeling that social contact is burdensome and pointless. This can cause a snowball effect, making them lonelier and more depressed. It can feel like a great deal of effort for depressed people to act “normal” or happier than they are. While social contact with loved ones or close friends can be beneficial to those who are depressed, pushing a depressed person to socialize simply for the sake of socializing can sometimes backfire, causing them to feel worse. It is important to check in with your depressed partner about what feels helpful, and only then nudge him to take the steps that you both agree would be helpful.

Judgment of self or others

I had a patient put it succinctly once: “Sometimes I feel like I hate everyone, but I hate myself the most.” Since depression is often the result of turning one’s anger against oneself, an important sign of depression is when your partner is overly hard on themselves for mistakes, frequently says negative things about themselves, or has difficulty realizing and really “feeling” the positive aspects of who they are. This can result in your depressed partner being very judgmental of themselves. Since we often treat those around us as we treat ourselves, they also may become judgmental of those who are closest to them, even you. They can hold you to unrealistically high standards, or be very dismissive. Again, instead of criticizing back, the most useful tack is try to be sympathetic, for example by saying something about how painful it must be to feel like everything sucks.

Abuse of alcohol or drugs

“I’m just having fun! Relax!” can be the refrain of someone who is using substances to ease their pain. People who are depressed sometimes use substances to try to “treat” their emotional pain, or “self-medicate.” Abusing alcohol or drugs only leads to more emotional problems of course, and puts off the process of learning to cope with the feelings by using their internal resources. Your spouse may need substance abuse treatment in addition to psychotherapy to address this issue.

What to do?

Now that you’ve identified the warning signs of depression, what do you do if your spouse is suffering from depression? Addressing depression can be a very tricky task, especially if the depressed person is resistant to admitting the problem.

Empathize

Compassionately talk with your partner about your concern. They may or may not be open to talking, but compassionate interest is a necessary ingredient in any effective approach. If they are simply unwilling to talk, you may need to back off. If they experience your concern as criticism, try to reassure them that you only have their best interest in mind, and that you don’t want them to feel alone in their suffering.

Describe your own experience

It is important that your partner hear from you what it is like to be around them when they are depressed. Especially if they are in denial or refusing to get treatment, it may be important for them to understand how their depression affects you emotionally, so that they can see the seriousness of the problem. The object is not to make them feel guilty or blame them, but to help them come to grips with the realities around their depression. Spouses often hide how they feel from partners for fear of hurting them, when in fact keeping their experience secret can prolong the pain. It is also important not to expect your partner to take responsibility for your feelings. You are just sharing your reality so that he can take it into consideration.

Don’t take responsibility for their feelings, either

We are all responsible for our actions, as well as the way we feel. Of course if you did something to hurt your spouse, you need to take responsibility for this, but partners are rarely responsible for their partner’s depression. Many partners feel as if they should somehow have the power to heal or help fix the depression, causing them a great deal of stress. In reality, depression is a serious, complicated disorder that almost always requires the help of a professional. For a partner to take responsibility for their partner’s feelings is not only ineffective, it is often harmful, causing undo stress on the relationship, and prolonging the healing process. Having healthy boundaries is not only necessary for a good relationship, it also is very important to retain your own sanity while trying to be helpful to your partner.

I had a client describe her husband as follows: “He just mopes around all the time! He drives me crazy.” When we dug deeper, we discovered that the thing that was driving her most crazy was the fact that she was feeling angry at herself for not being able to fix him. This often causes the depressed partner to feel like a burden, worsening the depression. It is okay for you to feel good even though your partner is depressed.

Seek help

There are many therapies that are effective for depression. I prefer a modern insight-oriented approach, since I believe that it gets to the root of the problem and produces long-lasting results, as well as other benefits, instead of covering up symptoms temporarily, like some quick-fix therapies do. I make myself available to anyone who is looking for a good therapist, since the process can be very difficult. Medication or alternative therapies have also shown promise in treating depressions that don’t respond to therapy.

The following is a transcript of a recent interview I did with Psych Central about advice around depression. You can read the Psych Central article here.

PC: What do your clients typically say about hope or their struggles with depression?

JL: Many of my clients, especially when beginning therapy, have been in a rut for some time, and are sometimes convinced that their depression won’t lift, or that their depressed state is simply how life feels. Depression often robs you of the memory of joy or happiness, so it becomes difficult to draw on happy memories to give one hope for the future. Most patients also are very confused about how they became depressed, believe there is something fundamentally wrong with them, and may even be beating themselves up for feeling that way, which makes them feel worse.

PC: What reasons do they give for losing hope?

JL: Most patients don’t know how they became depressed, while other have theories that are often incomplete. Often, depression makes hope feel futile as if hope is foolish or an illusion. The whole world can feel like a very dark place. The darkness feels like reality, not simply a lens which is distorting reality. That is how profound the experience of depression is. Even to say that one is hopeless requires a capacity that many depressed people don’t have: to put words to an experience that just feels as real and encompassing as the air they breathe. Saying one feels hopeless is often a positive step because it holds the implication that hope is something that is possible.

PC: What encouraging words can you share with readers who have lost hope and are struggling?

JL: That your readers are reading this means that they do have some hope that something can help them. People suffering from depression often receive well-meaning but simplistic advice which would make healing from depression seem easy or quick. “Just look on the bright side”, “Try to appreciate what you have,” etc. I am careful not to give advice that can feel simplistic because that can minimize their experience of depression and can increase their sense of hopelessness if the advice doesn’t work. To the degree that patients are able to take good care of themselves, great, and the more the better, but I want you feeling worse just because the quick fixes don’t help.

I often encourage them to try to be patient with themselves in the process of healing from depression, and that at the same time, tell them that therapy really works. Sometimes, depression can lift fairly quickly with insight, and other times it takes a while, but if you stick with a good therapist, you will nearly always find relief.

We get messages from our culture that somehow we should be in control of whether we are depressed, flip some sort of switch through sheer will power but I’ve never met anyone who has located such a switch, and such a message can be very destructive. Some people are capable of pushing through their symptoms to function, but that doesn’t mean they are happy, and others simply are not in a place to do it. If you accept your feelings as they are, then you have just conquered an important layer of your depression.

Most often, a loss of hope represents a loss of belief that you matter in the world, that you can be loved. Everyone, of course, is born lovable, but through the message, we receive we’re often made to believe that we need to perform to a certain level to be worthy of love. I have never met a person who feels lovable and is depressed at the same time. I tell my depressed patients that in our work, we will understand together the reasons that they don’t feel adequate or lovable and that the relationship between us will be the arena in which we will learn.

A loss of hope or meaning is often an indication that hope and meaning are being attacked by internal forces. Depression is most often the result of relentless internal attacks on the self, positive feelings, and positive thoughts. Bearing this in mind can be important because it offers a solution to the problem that you and your therapist can do something about by catching these attacks when they happen. Often, when you are beating up on yourself, you are really angry at someone else, and taking it out on yourself without knowing it.

As you are probably gathering, I offer hope through showing you that insight is possible and helpful and that you are worthy of attention and affection. Having said all this, I do offer, under some circumstances and when the timing is right, specific advice around self-care that can sometimes help to take the edge off of depressive symptoms or help to manage them. One piece of advice I often give is to take some time every day for activities that feel comforting or nurturing to your soul. It is also important to resist the temptation to isolate, if possible. Reaching out to people who are safe and loving often helps. If they lack those people, I try to help them figure out the obstacles to finding those relationships. Ideally, we all have someone we can just be with, without feeling the need to perform.

PC: If you didn’t mention this above, why is there always hope for someone struggling with depression?

JL: I would say there is always hope simply because high-quality treatment is effective for the vast majority of people suffering from depression. Some depression requires a short treatment to work, and other takes a long time, but I have never met a patient who didn’t see significant progress if they stuck with it. Again, how hopeless you feel does not correlate to whether you can feel better. Other treatments are also available for patients whose depression does not respond to therapy and medication, such as Transcranial Magnetic Stimulation, or Electroconvulsive Therapy, to name just two.

PC: Anything else you’d like readers to know about depression and getting better?

JL: Again, under the appropriate circumstances, I tell patients that in addition to getting therapy and finding good relationships, getting exercise, watching one’s diet, and getting a good sleep are very important in terms of one’s day to day moods, since the mind and body are closely connected. Blood sugar levels are particularly important for some people since a low blood sugar level can increase depressive symptoms. Poorly regulated caffeine intake can also cause fluctuation in moods, and alcohol can affect sleep and leave one feeling depressed for up to 24 hours afterwards.

You should also bear in mind that many people have even used their experience of depression to fuel tremendous accomplishments, as well as their empathy for the suffering of others. Not only are you in good company, but incredible things can come out of your battle with depression. Try to bear in mind that what you are going through is a normal part of the human condition, as painful as it is. There are support groups and people who you can find who will care. You are valuable and deserve to be happy and loved. You only have to remove the obstacles to believing this yourself.

I often get asked some version of the question of “I have this friend that needs therapy, and won’t get it. What’s going on?” In a previous post, I discussed one particular reason that keeps some people from seeking the help that they need (“Too expensive!”). I want to tell you about 3 other reasons that may cause people who need therapy not to seek it.

1. Fears of entering a relationship I would estimate that fear of intimacy, or relatedly, fear of vulnerability, is the number one reason why people who need therapy actually avoid it. Many other reasons, such as money and time, are often disguises for worries about what it means to be vulnerable with another person. We have all been hurt, and to the extent that we have been hurt, we tend to want to protect ourselves, in conscious and unconscious ways. Often this protection comes in the form of keeping an emotional distance from others. Therefore, to the extent that someone has been hurt, they are understandably very nervous about the prospect of entering into a relationship with another person. “But it’s just a professional relationship,” some people say. While it’s true that the therapist is a professional, feelings that come up in therapy are very much like relationships in “real-life.” In actuality, these feelings form the very basis for what makes therapy powerful, and helpful, but they also make it scary. After all, would you really expect that you would share all of your innermost thoughts with someone and not feel anything towards them? The very patterns that are causing you problems in your own life are the ones that need to be addressed in therapy, and in the context of the therapeutic relationship. We have learned over the past 50 years of research and thinking in the field of psychotherapy, that the relationship between the therapist and the client or patient is the single most predictive factor of whether therapy will be helpful. A skilled therapist is one who understands this idea and is able to navigate this relationship through their understanding of both their client and themselves, in a way that leaves the patient with a great deal of knowledge about themselves, and a renewed sense of safety and freedom within the context of their relationships. Important note: We can even be scared and not know we are scared. Our minds have a way of avoiding what we are afraid of, without even letting our conscious minds know what’s going on. All of our defenses fill this purpose: Denial, humor, intellectualism, escapism, and many others. ALL of us all of these defenses on a daily basis to get through life. The defenses are not the problem. We need them. It is when these defenses become too rigidified that we run into problems. More on this in another post.

2. Trust issues Trust issues can lead to a person not wanting therapy since a certain amount of trust is required to walk in the door of a therapist’s office. If someone has been hurt often or deeply enough, their trust in others, especially an authority figure like a therapist, may be too low to even take the plunge of going to a first session. Some may make the first session, but then get nervous about how much they revealed, and not come back. Parents are our original authority figures. To the extent that our parents violated our trust, hurt us, took advantage of us, didn’t listen well, or left us, we will have a distrust of people who are supposed to be caring for us. We might not want to admit it, and think of ourselves as “over” what our parents did to us, but that’s just how it works. Kids are innocent creatures, absorbing much of what our parents are putting out, and very sensitive to their reactions and treatment of us. If you think about it, this makes sense from an evolutionary perspective, because children in many cases benefit from their parents’ experience: what to avoid, how the world works, how to have relationships with others. Some of this is pre-programmed, but we are often “programmed” to learn from our parents, for better or for worse, and often unconsciously. We just absorb it without even knowing it.

3. Bad experiences with therapy Another major reason people are anxious or worried about beginning therapy is that they, or someone they know, have had a bad experience with therapy. This is usually either because the therapist was not very good, or because it brought up painful feelings, or both. How do you know which it is? This is a tricky question, but the basic answer is that if the feelings that came up in therapy are also feelings that you have had in other relationships, then it may be because therapy brought up important feelings, not necessarily that the therapy or therapist was low quality. If the feelings that you had weren’t at all similar to feelings you have in other relationships, then it may have been the therapy. If you bring up your feelings about the therapy with the therapist, they should not be defensive, but rather should be able to be curious with you about what those feelings mean, and what may have happened between the two of you that you can learn from. Again, this is a normal and necessary part of a good therapy. If you feel that you are learning things and covering new ground, not just intellectually, but emotionally, even if the emotions are painful, these are signs that the therapy is likely productive.

These are a few of the many reasons that people needs therapy don’t get it, all having to do with worries about having a painful or negative experience. Starting therapy is scary for everyone on a certain level, but given that it can change your life, it’s so worth it!

I should note that there are other factors involved in the decision not to go to therapy, even though one is suffering. A person may not believe that it is helpful, or they may have cultural beliefs that would point them in other directions for their relief. It is important to note that I am just discussing some of the factors that may be out of people’s awareness, and I have a belief that most people can use therapy at one time or another, but not everyone shares this belief.

For my next post, I’ll answer the question of how to get help for a friend who needs it. That is: “Okay, I understand why they aren’t going, but how do I get them to go?”

Please comment, share, email me with questions, and stay tuned for more posts! Also, if you have ideas for what you’d like to hear more about in future posts, I would be glad to hear and consider them!

Many patients and therapists alike are reporting worry about recent developments in the world around us. “The bees are going extinct.” “There is a demagogue on the rise.” “The planet is warming up.” Some people will let their mind even go so far as to worry, that is any of these things winds up in a worst-case-scenario situation, that civilization as we know it can collapse. As far-fetched as it may sound to some, we only have to look on the news to find other places where civilization is not providing its citizens the basic sense of safety that we except from civilization. We don’t even have to leave the border of our country, state or city to find places where citizens don’t feel safe in their own neighborhoods. We usually repress the knowledge that we can easily be the person who is homeless, destitute, or the victim of a crime. Same goes for a civilization, like Syria, that has collapsed. We KNOW this could easily be us. That is WHY we tell ourselves that it couldn’t possibly be. When we get daily reminders that it could happen to us, they become harder to ignore. I believe that this is what Martin Luther King Jr. meant, in part, when he said “not one of us is free unless we all are free.” The suffering that we see in the world, and that we are warned may happen to us, does affect us, often on a level of which we are unaware.

Most of us, if all is going well, deal with such worries (aka anxiety) by remaining in what is referred to as “healthy denial.” After all, would we really cross the street or go in the water if all we had in our mind was buses ramming into us or sharks attacking? So we put this stuff out of our minds so that we can go through our daily lives with a belief in our safety, which, by the way, is a prerequisite for enjoying life.

So how do we deal with such “everyday anxiety” that is caused by the realities in the world around us? Well, being honest with those that care about us about how we are feeling is a good start. Sharing how we feel with others may sound cliché, but it works. We feel less alone, we can bounce our ideas off of others, and we can get a reality-check on our ideas. Also it’s important to keep in mind that we only actually need to let worry into the extent that it helps motivate us to fix a problem. No more. So think about it, then think what you can do about it, then try to forget it until you need or want to problem-solve some more. Forgetting, at least temporarily about a problem that we can do much about, will allow us sleep, and enjoy our day. So, in brief, talking about it, doing what you can about it, then forgetting it so you can enjoy your life are the three steps that I recommend in dealing with such “everyday” anxiety.

Some caveats, however: If someone is sharing their worries with you, don’t give them immediate advice, unless they are asking for it, and do not, under any circumstances, say or imply that they should feel differently than they do. This only serves to make the person feel worse, be less apt to share their feelings, and take in the message that their feelings are wrong. This usually happens when someone is stuck in how they are feeling and the listener doesn’t know what else to do besides tell them to stop feeling what they are feeling. If someone is truly stuck, this may be a time to recommend a professional. This article predicted that as climate change continues to increases and shape the planet, mental health issues will rise significantly. All the more reason to learn to be attentive to those around you. If you enjoyed this piece and want more, please share on Facebook. Comments or criticisms? Please email me. I’d be glad to get your feedback. Thanks!

Many people ask me some version of the question: “Do I need therapy?” “Needing” therapy depends on your definition of the word. If you are suicidal, then you may need therapy in order to survive. Most people just “need” therapy, not to survive, but in order to be happy. In other words, they would survive without it, but they could be happier with it. Since therapy does not usually mean the difference between life and death, many people therefore see therapy as a luxury. This sentiment has complex roots in how we view our emotions in general, both personally and as a society.

We have a notion as a culture that if something is just “in our head” we should be able to change it right away. Even more relevant is that many people were taught growing up, either explicitly or implicitly, that their feelings are unimportant. This leads them to feel that paying attention to them and getting help for them is overly indulgent, because they aren’t important anyway. I might counter: What is the point of life if we don’t feel some sense of happiness, satisfaction, pleasure, or meaning? If feelings are kind of the point, then how can they be a luxury? Many people are willing to buy themselves a nice new car, but unwilling to spend money on therapy, since they consider that to be a “luxury”.

I will have to leave this rich topic here for the moment, but will wrap it up by suggesting that with good therapy, one often begins to appreciate the things in life that are free and abundant (our relationships, the beauty around us) as much or more than anything we can buy with money. I will be discussing in future blog posts other reasons that people who could be helped by therapy may not seek it.

I created this space to share insights and interesting articles that may be helpful to those in treatment, seeking treatment, or for loved ones in need. Feel free to email me if you have comments or questions. -John Lundin, Psy.D.